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Live Health Chat

Migraine and headaches: 'Ask the Experts' Wednesday at noon

By Prue Salasky

11:11 AM EST, February 23, 2011

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The Daily Press held a live health chat on Wednesday, February 23, on migraine and headaches. Dr. Ben-Othmane, a neurologist and headache specialist with Hampton Roads Neurology Inc. answered your questions.

To read the transcripts of previous health Web chats, go to www.dailypress.com/health and click on the tab, Archived Live Web Chats.

Welcome Readers! At NOON today we'll be talking to neurologist Kamel Ben-Othmane about migraine and headaches. Please feel free to post your questions now, ready for him to respond.

Wednesday February 23, 2011 11:44 Prue

11:45

Prue:

I have received several e-mailed questions and will be posting them soon. If you can't stay for the chat, after 1 p.m. go to www.dailypress.com/health and click on Archived Live Web Chats for the transcript of all our Health chats.

Wednesday February 23, 2011 11:45 Prue

11:51

[Comment From Jenny BJenny B: ]

My 11-year-old daughter has migraines especially around a cold front. I give her Motrin s. What else can I do for her.

Wednesday February 23, 2011 11:51 Jenny B

11:51

Prue:

Our doctor will be here at NOON to start answering your questions. Feel free to submit them now.

Wednesday February 23, 2011 11:51 Prue

11:59

Prue:

Dr. Ben-Othmane, please let our readers know when you;re ready to start answering questions. We already have a dozen in the queue for you.

Wednesday February 23, 2011 11:59 Prue

12:01

Prue:

Readers: A reminder that you can always find the transcripts of previous health chats at www.dailypress.com/health and click on the tab, Archived Live Web Chats.

Wednesday February 23, 2011 12:01 Prue

12:01

Kamel Ben-Othmane:

Hi, I am Dr Kamel Ben-Othmane, I am a neurologist with Hampton Roads Neurology, part of Riverside Medical Group. I am looking forward to answering your questions regarding migraine and headaches in general.

Wednesday February 23, 2011 12:01 Kamel Ben-Othmane

12:02

Prue:

Welcome Dr. Ben-Othmane, could you answer Jenny B's question about her 11 year old daughter being affected by cold fronts.

Wednesday February 23, 2011 12:02 Prue

12:02

[Comment From RSRS: ]

Does weather /pressure really affect migraine sufferers

Wednesday February 23, 2011 12:02 RS

12:03

Prue:

I'm hoping you're a fast typist Dr. Ben-Othmane because we have so many questions!

Wednesday February 23, 2011 12:03 Prue

12:04

[Comment From Pat RPat R: ]

What can be done when the barometric pressure is the culprit for migraines?

Wednesday February 23, 2011 12:04 Pat R

12:04

Prue:

I'm trying to group all the "weather" questions together for your answer.

Wednesday February 23, 2011 12:04 Prue

12:05

Kamel Ben-Othmane:

Jenny B. Motrin is fine. If the headaches don't respond to motrin or other simple analgesics, you may want to talk to her pediatrician and consider other treatment options such as triptans. This class of medications is usually more eefective for migraine.

Wednesday February 23, 2011 12:05 Kamel Ben-Othmane

12:06

[Comment From RSRS: ]

Do weather changes/pressures affect migraine;

Wednesday February 23, 2011 12:06 RS

12:06

[Comment From JoanneJoanne: ]

I will always and continue to be grateful to Dr. Kamel Ben-Othmane for his care and expertise. Thank you.

Wednesday February 23, 2011 12:06 Joanne

12:06

Kamel Ben-Othmane:

RS, very much so. Weather/pressure changes are very common triggers, precipitating factors for migraine.

Wednesday February 23, 2011 12:06 Kamel Ben-Othmane

12:06

Prue:

Thanks Joanne for the recommendation!

Wednesday February 23, 2011 12:06 Prue

12:07

Prue:

So, what can people do when the weather precipitates a migraine?

Wednesday February 23, 2011 12:07 Prue

12:08

Kamel Ben-Othmane:

Pat R. Nothing specific. You need to treat them the same as you usually do. You need an abortive medication, a rescue medication and if they are frequent a preventative medication (a medication you take daily to make the headaches less frequent, less severe and more responsive to treatment.

Wednesday February 23, 2011 12:08 Kamel Ben-Othmane

12:09

Kamel Ben-Othmane:

Joanne, thank you.

Wednesday February 23, 2011 12:09 Kamel Ben-Othmane

12:10

Prue:

Doctor -- could you expand on what an abortive medication is, a preventive and a rescue. And are there limits on how long one should stay on medications? We have questions about Topamax coming up.

Wednesday February 23, 2011 12:10 Prue

12:10

[Comment From JillJill: ]

What is the best pain reliever to use?

Wednesday February 23, 2011 12:10 Jill

12:10

[Comment From JillJill: ]

What do you think of Topamax?

Wednesday February 23, 2011 12:10 Jill

12:10

[Comment From RSRS: ]

If on Topamax for daily prevention of migraines, is it better to remain on bc pills to maintain estrogen levels? What does menopause mean for that

Wednesday February 23, 2011 12:10 RS

12:12

[Comment From Pat RPat R: ]

We are also warned about rebound headaches, what are we to do when the headaches sometimes are chronic?

Wednesday February 23, 2011 12:12 Pat R

12:13

Prue:

Dr. Ben-Othmane has already answered Pat's question above -- just so that readers can follow his answer.

Wednesday February 23, 2011 12:13 Prue

12:13

Kamel Ben-Othmane:

An abortive medication is a medication (prescription or over the counter) that you take as needed to stop a headache when you have one. Typically is a triptan (imitrex, maxalt, zomig...). But other classes of meds can be used. A rescue medication is a medication that you would have with you and use when your main abortive drug didn't work. A preventative medication is taken daily.

Jill. There is no particular medication that is best overall. Every one is different. Over the counter anti-inflammatory meds (ibuprofen, naprosyn, tylenol) are fine if they work. Triptans are more effective. Fioricet and narcotics can be used but are more likely to cause rebound and addiction.

Wednesday February 23, 2011 12:16 Kamel Ben-Othmane

12:17

[Comment From ElaineElaine: ]

I'm 47 and have suffered migraines with aura since I was 19. They used to occur monthly; now they go in spurts - 7 in 3-week period and none for a while. Topamax was disastrous. Why can't they be regulated by estrogen therapy?

Wednesday February 23, 2011 12:17 Elaine

12:17

Kamel Ben-Othmane:

Jill, Topamax is a good migraine preventive medication. It is by far the most commonly used medication to prevent headaches.

Wednesday February 23, 2011 12:17 Kamel Ben-Othmane

12:18

Prue:

Doctor - could you address the issue of estrogen -- and whether birth control pills should be used?

Wednesday February 23, 2011 12:18 Prue

12:19

[Comment From GuestGuest: ]

What headache reliever can I take while pregnant?

Wednesday February 23, 2011 12:19 Guest

12:20

Kamel Ben-Othmane:

RS. You dont have to stay on BC pills if you are on topamax but you can. The effect of BC pills on migraine is variable. Topamax can reduce the effect of BC pills at high dose, but not at the usual headache dose of 100mg/day.

Many migraine patients will see improvement of the headaches after menopause, but not always.

Wednesday February 23, 2011 12:20 Kamel Ben-Othmane

12:20

Prue:

Readers, we're chatting with Riverside neurologist, Dr. Kamel Ben-Othmane. He's answering questions about headache and migraine. It's obvious from the number of questions that this is a widespread problem. Please be patient while he gets to your question.

Wednesday February 23, 2011 12:20 Prue

12:21

[Comment From JDJD: ]

Comment for @Lori: as a migraine sufferer, I can tell you that you have to take abortive pills *before* things get bad. After a while, you develop a sense for when a headache *may* be a migraine and take an abortive right away. I like Imitrex because it's generic (meaning cheap) so I can take the pill without worrying about the expense.

Wednesday February 23, 2011 12:21 JD

12:21

[Comment From PJPJ: ]

I suffer from vertigo. CT scan, eye, ear exams all normal. I do have a history of migraines in family and I see aura but have no pain. Could vertigo be related to migraines. I feel fullness in my right ear.

Wednesday February 23, 2011 12:21 PJ

12:22

[Comment From Pam OPam O: ]

are migraines and vertigo related?

Wednesday February 23, 2011 12:22 Pam O

12:22

Kamel Ben-Othmane:

Pat R. With chronic migraine, the focus should be on preventative therapy (sometimes a combination of more than one drug is needed). We also use nerve blocks, botox injections, biofeedback etc.. Limiting the quantity and frequency of abortive medications used is also important.

Wednesday February 23, 2011 12:22 Kamel Ben-Othmane

12:23

Prue:

Readers: If you can't stay for the whole chat -- we're here until 1 p.m., then check back at www.dailypress.com/health and click on the tab Archived Live Web Chats to find the transcript.

Wednesday February 23, 2011 12:23 Prue

12:24

Kamel Ben-Othmane:

Lori. If the headaches remain a problem and you GP has no other suggestions, seeing a specialist may be a good idea.

Wednesday February 23, 2011 12:24 Kamel Ben-Othmane

12:26

Prue:

And vertigo -- is it related?

And here's an emailed questioned: I have been diagnosed with a mixed headache syndrome, which I understand is a form of migraine headaches. I have had daily headaches for about a year and a half. Some of them are debilitating and others are not. How long should I treat with a neurologist for them prior to considering pain management. I am tired of living with pain and the meds that we have tried so far, i.e. neurotin, maxalt, and others, do not seem to work.

Wednesday February 23, 2011 12:26 Prue

12:26

[Comment From JillJill: ]

I have seen improvement of my headaches after menopause. I do find the most relief from migraine otc aspirin, acetaminephin and caffeine..and just taking one pill seems to work better than taking two. Sometimes you can tell nothing is going to work.

Wednesday February 23, 2011 12:26 Jill

12:26

Kamel Ben-Othmane:

Elaine, sometimes estrogen therapy helps, but not always. Hormones play an important role in migraine but they are not the only factor. Topamax didn't work for you, but fortunately there are other treatment options.

Wednesday February 23, 2011 12:26 Kamel Ben-Othmane

12:27

[Comment From GuestGuest: ]

Is there a difference from spinal headaches and migraines?

Wednesday February 23, 2011 12:27 Guest

12:29

Prue:

Dr. Ben-Othmane is answering questions as fast as he can. Thanks for your patience.

Wednesday February 23, 2011 12:29 Prue

12:29

Kamel Ben-Othmane:

During pregnacy, the treatment options for migraine are limited. Typically migraine improves on its own during pregnancy. Vicodin or percocet can be used infrequently. None of the preventive meds is completely safe, Magnesium 400 to 500 mg/day can be helpful. We frequently use greater occipital nerve blocks to prevent headaches during pregnancy.

Wednesday February 23, 2011 12:29 Kamel Ben-Othmane

12:30

Prue:

Dr. Othmane has answered questions about weather-related migraine and different medications used. Read above for those answers.

Wednesday February 23, 2011 12:30 Prue

12:30

Prue:

Dr. Othmane -- what about the vertigo/migraine connection?

Wednesday February 23, 2011 12:30 Prue

12:31

Prue:

Readers: We're chatting with Dr. Ben-Othmane a neurologist who specializes in headaches and migraines. We're here until 1 p.m. for your questions.

Wednesday February 23, 2011 12:31 Prue

12:31

Kamel Ben-Othmane:

PJ. There is a condition called vertiginous migraine. Rarely vertigo can be a manifestation of migraine. However, if the vertigo occurs separately from the headaches it is more likely to be an inner ear problem.

Wednesday February 23, 2011 12:31 Kamel Ben-Othmane

12:31

[Comment From GuestGuest: ]

My friend gets migraines when meals are later than usual. Is that unusual?

Wednesday February 23, 2011 12:31 Guest

12:31

[Comment From t solomont solomon: ]

I have morning headaches every day, and after a big meal

Wednesday February 23, 2011 12:31 t solomon

12:31

Kamel Ben-Othmane:

O, please see answer to PJ question.

Wednesday February 23, 2011 12:31 Kamel Ben-Othmane

12:32

Prue:

I see we have some food/meal-related questions. What's your take on the connection with migraine?

Wednesday February 23, 2011 12:32 Prue

12:34

[Comment From PatPat: ]

My husband has had migraine headaches for about 18 years. The pain is worse on his left side. He has tried Treximet, Stadol nasal spray gives relief. He has has MRIs and CT scans. He thinks he might have a tumor. He is 57.

Wednesday February 23, 2011 12:34 Pat

12:34

Kamel Ben-Othmane:

I am not sure what spinal headache refers to. Often migraine start with or cause neck pain. Spinal tap headache, is a headache that can occur after a spinal tap and that's different from migraine. Sometimes arthritis or other bony changes in the neck can cause headaches and that is also different from migraine.

Wednesday February 23, 2011 12:34 Kamel Ben-Othmane

12:35

[Comment From RobinRobin: ]

My father, sister and myself all have migraine headaches. Is it possible for them to be hereditary.

Wednesday February 23, 2011 12:35 Robin

12:35

[Comment From AnneAnne: ]

Migraines run in our family but usually the women. I notice that my son often has flaming red ears, is that a warning sign that he might be prone to them also?

Wednesday February 23, 2011 12:35 Anne

12:35

Kamel Ben-Othmane:

Guest. Not unusual, hypoglycemia (drop in blood sugar) is a common trigger for migraine.

Wednesday February 23, 2011 12:35 Kamel Ben-Othmane

12:37

[Comment From beabea: ]

where is your office and what insurance do you except

Wednesday February 23, 2011 12:37 bea

12:38

Kamel Ben-Othmane:

T Solomon. Sleep apnea can cause morning headaches. Do you snore? Do you have daytime sleepiness? If you do you may need to be evaluated for sleep apnea. Migraine and other headache types can also occur in the morning.

Wednesday February 23, 2011 12:38 Kamel Ben-Othmane

12:39

Prue:

Dr. Ben-Othmane, we have several questions about migraine in MEN -- are there different triggers than with women. Different treatments?

Wednesday February 23, 2011 12:39 Prue

12:39

[Comment From DavidDavid: ]

I suffer from migraines every year from sept till the middle o oct. they occur at the same time everyday during that period. Do you know what causes this?

Wednesday February 23, 2011 12:39 David

12:41

Kamel Ben-Othmane:

Pat, If MRIs have been negative, then he does not have brain tumor. If the headaches changed or worsened since the last imaging study, he may need repeat MRI/CT. Otherwise he may need more aggressive treatment if his headaches.

Wednesday February 23, 2011 12:41 Kamel Ben-Othmane

12:41

Kamel Ben-Othmane:

Robin, Definitely. Migraine has a significant hereditary component.

Wednesday February 23, 2011 12:41 Kamel Ben-Othmane

12:42

Prue:

Readers: You have until 1 p.m. to ask your questions about headache and migraines from Riverside neurologist Dr. Ben-Othmane. He's answered questions already about estrogen therapy, medications, weather-triggered migraine, and

Wednesday February 23, 2011 12:42 Prue

12:42

[Comment From JemJem: ]

I have suffered from migrains for well over 20 years and for the past 10 years my vision has been affected by it-what I mean is that I loose partial sight in my left eye when I begin to have a migrain. Is this the norm.

Wednesday February 23, 2011 12:42 Jem

12:42

[Comment From NancyNancy: ]

Just joining. I used to get migraines around my menstrual cycle. I haven't had one in ages. They started when I was 40 and stopped around 49. I have not gone through menopause. Can this happen?

Wednesday February 23, 2011 12:42 Nancy

12:42

Kamel Ben-Othmane:

Anne, not that I know of.

Wednesday February 23, 2011 12:42 Kamel Ben-Othmane

12:43

[Comment From Tiffany GTiffany G: ]

I always seem to have migrames around my time of the month. Also seem to get them when a light comes on to quickly. I usually take excedrine migrane to solve the issue, but lately its not helping. I have a medicine that is perscribed by my doctor which helps, but it makes me naushous. When I take Excedrine Migrane I need to make the room dark and have some pressure on my head for the pain to be relieved. I usually fall asleep and when I wake up I feel fine. What could be a cause of my migranes when its not my time of the month?

Wednesday February 23, 2011 12:43 Tiffany G

12:44

Prue:

Anne was asking about "flaming red ears" being a symptom of impending migraine. The doctor's answer --not that he knows of.

I have had migrains for twelve years, seen various doctors, been on various meds, currently 350mg of topamax a day. Still at least four headaches a month. I am thirty five now and wonder if there is something I might do to try to reduce headaches on my own-or anyone in general? Vitamins, lifestyle changes, things of that nature?

Wednesday February 23, 2011 12:45 Melissa

12:46

Prue:

Doctor -- could you give some tips on triggers other than hormones and weather?

Wednesday February 23, 2011 12:46 Prue

12:46

Kamel Ben-Othmane:

David. That can be seen with migraines. However, cluster headaches should be considered given the pattern of seasonal clustering.

Wednesday February 23, 2011 12:46 Kamel Ben-Othmane

12:46

[Comment From DonnieDonnie: ]

My wife had a constant migraine, meaning every moment of every day, for nearly 3 years and was finally able to get help from a special head pain institute in Michigan. She still suffers from migraines some and found that food and certain lifestyle factors can trigger migraines. What sort of dietary and lifestyle habits do you recommend for minimizing migraines and headaches?

Wednesday February 23, 2011 12:46 Donnie

12:46

[Comment From KathyKathy: ]

I wake up with a migraine several times per month. Consequently, I have never benefited from meds such as Imitrex. What makes a migraine occur during sleep?

Wednesday February 23, 2011 12:46 Kathy

12:47

Prue:

Could the sleep headache be from dehydration?

Wednesday February 23, 2011 12:47 Prue

12:48

Kamel Ben-Othmane:

Jem. What you describing is the visual aura of migraine. It is possible that someone gets migraine without aura for years, then one day start experiencing mifraine with aura. It is not the norm, but is possible.

Wednesday February 23, 2011 12:48 Kamel Ben-Othmane

12:48

[Comment From Pat RPat R: ]

Is it normal to start having auras before a migraine, when you never did in all the previous years? I've started having them in the past year. Before if I did lots of yawning the day or night before, I'd get a migraine the next day.

Wednesday February 23, 2011 12:48 Pat R

12:49

Kamel Ben-Othmane:

Nancy, this can happen. Migraine is unpredictable and the pattern you described is not unusual.

Wednesday February 23, 2011 12:49 Kamel Ben-Othmane

12:49

Prue:

Readers- we have so many questions that I'm going to ask the doctor if he'll answer some of them after the chat. I'll publish the answers in the Daily Press in a follow-up article - you can find it online at www.dailypress.com/health

Wednesday February 23, 2011 12:49 Prue

12:49

[Comment From TT: ]

I have passed out in the past and been diagnosed with Migraines.....no MRI or CT scan. Is that possible? I've been prescribed Imitrix when I feel them coming on. How do I know that is exactly what caused me to pass out?

Wednesday February 23, 2011 12:49 T

12:50

[Comment From TT: ]

Because I saw spots and flashes prior to passing out, they are assuming these are aura migraines.

Wednesday February 23, 2011 12:50 T

12:51

[Comment From RSRS: ]

Is there really no cure in sight for migraines? Just avoiding triggers and using preventive medications like Topamax and pain meds like Axert or Frova or natural supplements like B2 vitamins and magnesium?

Wednesday February 23, 2011 12:51 RS

12:52

Kamel Ben-Othmane:

Tiffany G. Migraines are more likely to occur during menstruation due to drop in estrogen level. However, they can occur at any time of the month. You are simply, genetically predisposed to have them. You should consider preventive treatment if you can not find a good abortive treatment.

Wednesday February 23, 2011 12:52 Kamel Ben-Othmane

12:53

[Comment From MichelleMichelle: ]

Had a blood test for food sensitivites, suffered from migraines since age 9 (now 43) have them 2-3 per month, went off food that created sensitivities and in 2 months, NO migraines.

Wednesday February 23, 2011 12:53 Michelle

12:53

[Comment From JDJD: ]

@Melissa: you might want to check out Clair Davies' book The Trigger Point Therapy Workbook, especially the sections about the muscles of the neck. I've dramatically reduced my own migraines by massaging the trigger points in the back of my neck and the SCM muscle in the neck. Also, people who wake up with headaches/migraines might want to check this out it's easy to overstretch/strain your neck while sleeping. I very rarely wake up with headaches anymore, whereas I used to get them all the time.

Wednesday February 23, 2011 12:53 JD

12:54

[Comment From Pat RPat R: ]

I was on Topamax for about 3 years, it worked in the beginning, When it didn't seem to be working any longer I stopped using it. It seems like the auras (zig zag bright white circles) started some time after that. Plus lost weight and always was cold when taking Topamax.

Wednesday February 23, 2011 12:54 Pat R

12:54

[Comment From TerryTerry: ]

I have been taking various triptans over the last 5 years to treat my migraines and I'm concerned about the long term health effects of those medications. I have frequent migraines and I've tried Topamax and nortryptilene for prevention, but neither provided any help, and the Topamax was a nightmare for me. The abortive meds work great, but I am wondering if they do pose any long term risk?

Wednesday February 23, 2011 12:54 Terry

12:54

Kamel Ben-Othmane:

Melissa. Sometimes adding a second preventative therapy helps. Also consider nerve blocks and or botox treatment. Supplements that have been shown to help include magnesium, Vitamin B2, feverfew, petadolex. Also biofeedback and regular exercice. Avoid large quantities of caffeine.

Wednesday February 23, 2011 12:54 Kamel Ben-Othmane

12:55

Prue:

Doctor -- could you answer Terry's question about the long-term risks, if any, of abortive meds.

Wednesday February 23, 2011 12:55 Prue

12:55

[Comment From BrendaBrenda: ]

I have been having headaches since my c-section with my son two years ago. They put me on Midrin. I take it as needed along with cafffeinated sodas. If my headache doesn't go away is there anything else I can take along with the Midrin?

Wednesday February 23, 2011 12:55 Brenda

12:56

[Comment From JillJill: ]

I read to take butterbur in a health magazine and it gave me relief but then my ankles swelled...so I went off it. Why did that happen?

Wednesday February 23, 2011 12:56 Jill

12:56

[Comment From BarbaraBarbara: ]

What do you think of vitamin cocktails?

Wednesday February 23, 2011 12:56 Barbara

12:57

[Comment From BarbaraBarbara: ]

Would you recommend Diamond Clinic for chronic migraines? My 14 yr old suffers 24/7, has been hospitalized 4 times for dhe treatments which break them and recently has had 1 botox treatment. It has gone now to a sinus headache, what would you recommend next? She has been checked out with Opthamologist and is scheduled for ENT next. Any suggestions?

Wednesday February 23, 2011 12:57 Barbara

12:58

Kamel Ben-Othmane:

Donnie. For some patients, certain foods can trigger migraine. The list is however long and can be found on the internet. If she can identify a spefic food (MSG, red wine..) that consistently trigger her headaches she can avoid it. In general limiting diet rarely pays off. Also please see answer to Melissa's question.

Wednesday February 23, 2011 12:58 Kamel Ben-Othmane

12:59

Prue:

We just have a couple of minutes before the end of the chat. Again, as we had so many questions I'm going to ask Dr. Ben-Othmane to answer some of them later and print them in the paper and online at www.dailypress.com/health.

Wednesday February 23, 2011 12:59 Prue

1:00

[Comment From JDJD: ]

@Melissa, @Donnie: note that Magnesium Gluconate is much easier on the stomach than the other forms of Magnesium

Wednesday February 23, 2011 1:00 JD

1:00

[Comment From beabea: ]

there are alot of questions we all have why don't you have a

Wednesday February 23, 2011 1:00 bea

1:00

Prue:

Thanks so much for your participation and your questions. And Dr. Ben-Othmane for his expertise. His contact information is in this chat.

Wednesday February 23, 2011 1:00 Prue

1:00

Kamel Ben-Othmane:

Kathy, this is something that can happen with migraine. Those headaches are more difficult to treat. Imitrex injections can sometime help in these cases. Also consider conditions other than migraine (hypnic headache, sleep apnea, glaucoma, HTN...).

Wednesday February 23, 2011 1:00 Kamel Ben-Othmane

1:01

Prue:

We have to let the doctor go now. Thank you so much for your expertise. Look for the full transcript at www.dailypress.com/health under Archived Live Web Chats.

Wednesday February 23, 2011 1:01 Prue

1:02

Prue:

Thanks and bye! Join our chat on Friday at 11 a.m. on Boxing and how you can get fit and have fun.

Wednesday February 23, 2011 1:02 Prue

1:02

[Comment From DonnieDonnie: ]

@Barbara: Along with the Diamond Institute in Chicago, you should consider the Michigan Head Pain and Neurological Institute (MHNI) in Ann Arbor, http://www.mhni.com. I knew people who had been at the Diamond Institute and wound up at MHNI. My wife had great success in Michigan after being hospitalized 4 times at 3 different hospitals in the Southeast. They treat children there, too.